Barbour County index. [volume] (Medicine Lodge, Kan.) 1880-current, 1887-03-30
SURGICAL SKILL.
A Case Of Aneurisna IN the Neck
Succsssfnly Treated
low the Tying OF Arteries, One OF the
Delicate and Fascinating Feats In
Surgery, Was Pcrforned Ina
Eew York Hospital.
TN. Y. Cor. cincInna.i Eaaulrcr.l |

Among tho delicate operations in SUR
gerry there is none more fascinating than
tying arteries. Even though the ruptured
vessel is not large, there is sort OF
ghastly pleasure enjoyed by the surgeon
when he seizes the bleeding point and
watches the flow OF blood stop with the
consciousness that he has saved lfe.
When the larger arteries are to be tied,'
the element Of danger enters in large
degree, and increases as the arteries to
be tied approach the location of the heart
rhIs is especially true in the case of oper-
ations for aneurisms in the neck or chest
Among this class of operations there Is
none more dangerous than the tying OF
the subclavian artery. 1t was recently
done successfully at the St Elizabeth
Hospital by young surgeon, whose bold
ness and skill are fast raising him to an
elevated position among the many emf
nent specialists in this city.
The patient was a middle-aged colored
woman. The history of the case shows
that she was struck violent blow in the.
neck by hammer in the hand of her hus.
band several years ago. There was no
special effect save the pain and the bruise
at the time, but soon afterward a slight
swelling appeared on the right side Of her
neck. 1t was not troublesome at first,
developing slowly, but no Inconvenience
followed until some of the nerves were
affected, and then the pain was intense.
AS the tumor still increased in size, and
the pressure on the nerves became
greater, the woman suffered the most
sxcruclating agony all the time, and was
frequently thrown into convulsiona &
When admitted 10 the hospital the diam
ster of the tumor at its widest section was
about five inches. It's nature was readily.
determined. Its location was over the
subclavian artery, and every pulsation Of
the heart could be easily detected in the
tamor, which is one of tho distinguishing
characteristics of an aueurism. In fact IL
aad become so far advanced that 1t had
stretched the skin to such an extent that
the pulsation was visible TO the eye. With
The stcthoscope blowing or kissing sound
could be heard with each pulsation as the
blood rushed into the sac from the artery
In every aneurism there is a sac, which
IS formed by the rupture or dila-
ton Of an artery and communicates
with the artery. The blood, in
stead of flowing naturally through
he artery, empties into the sac. Tho sac
steadily increases IN size in the usual de-
7elopment of an aneurism until an in
domination is caused in the skin, which
causes it finally to slough, and then fatal,
bleeding follows, either with sudden
NuSH tudt SpCCully CiQo III uCaOu VI u olOW
>ozing. Aneurisms have been cured by
compression of the artery, manipulation
and artificial coagulation, but the usual
remedy is by the use of the ligiture, where
the artery is tied between the aneurism
and the heart, and the supply Of blood cut
)f.
Despite the hazardous nature Of the un-
iertaking, us soon as the precise loca-
lion of the aneurism was ascertained,
;he doctor determined to try the cure by
igature, this being the only chance
that was left in the advanced stage
)f the disease. The patient was accord
ngly taken 10 the operating room and
placed under ether Her head was turnel
20 the left side, and the right shoulder
vas depressed as much as possible. While
ltension was put on the flesh an incision
was made about four inches in length,
Just above and along the line of the
;lavicle or collar-bone, running from the
sdge of the sterno-mastoid muscle to the
TapeZius muscle in the back The incision.
was extended downward through the fat
and tissue with the greatest care until
| ;hc external iugular vein became visible.
A blunt hook was passed around the
rein, and IT was dissected loose from its
attachments and drawn to the side. The
| nastoil muscle, where it unites with the
| :oilar-bone, was found to be so broad as
20 interfere with the exploration, and IL
was detached from the bone and gently
turned loose and raised upward.
The knife was then laid away, as it was
| not deemed safe to use il further because
the slightest slip might cause fatal in
jury. Small probes, hooks and directors
were used to break up the tissue into
small sections, and this delicate work was
continued until the omophyold muscle was
fNNrsn hat. Nf sNo. n
position. Directly beneath it was the
pulsating subclavian. 1t could be felt,
but not seen. The lower end of the
omophyoid muscle was raised with q
blnnt hook and drawn backward. Several
veins which had been severed bled pro-
tGscly, and the operation had to be
stopped until tho hemorrhage was
checked. When this had been done, tho
surgeon introduced his forefinger into
the wound to locate the anterior
scalenus muscles. When this tough
hgament was found, the finger
was moved carefully downward
along lis course until the place where it
was inserted into the rib was reached
From this point it was easy to get the ex-
act course of the subclavian artery. The
surgeons finger was held at this place
while the search was made for the artery
above it. The tissue and the fat were
taken away in small pieces with small
probes, as it was determined not to put on
the ligature until the artery could be seen,
as it was not uncommon to tie up the lower
portion Of the brdchial plexus Of the
nerves instead of the artery, for which
they may be easily mistaken, as
they appear first. At last the ar
terry, with its peculiar color, came in view
and it was worked free from the fat and
tissue with the greatest care The most
difficult part of the opperation is to pass
the needle containing the thread under the
artery and then TO tie the ligature It was
aonc after long time by the aid of an in
gcnious contrivance. Before the ligaturs
was frightened the blood in the aneurisn
was forced out of the sac by pressure and
then the artery was closed by the thread
IL was Immediately followed by a spas
modic jump of the heart, and it was
thought that the end had come. Stimu
Iants were given in large quantities and
the patient revived. The operation lasted
three hours ard half.
| -
Crisp Ante-Mortcm Statement.
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